This Is Going to Hurt

Performing an elective caesarean section, assisted by a hungover medical student … Baby delivered, and just as I was sewing up the uterus, the student fainted, face-planting right into the open abdomen. ‘We should probably give the patient some antibiotics,’ the anaesthetist suggested.

Adam Kay

In medical school, we all think that we’ll be the doctor with a serviceable social life, enough residual zeal, and, all things considered, viable mental health. But as the title implies, even for doctors as optimistic and altruistic and humorous as Mr Kay (to still use his medical prefix, since surgeons go by Mr instead of Dr), sometimes the profession still breaks you.

The anticipated relatability of this was what kept me from articulating a review when I first finished his memoir almost a week ago. Not to mention our insane schedule from next month onwards, à la SARS-CoV-2 (though I’m happy Hong Kong hospitals are able to reopen their doors to us, I really am). Or my persistent OCD, with which I have grappled since secondary school.

Every lesson in the wards is a voluntary voyage between the Scylla and Charybdis of contamination – will my white coat touch a rubbish bin? A sputum sample? A patient’s urine? Barely making it through compulsory sessions is one thing; understanding the necessity of clerking (what we call strutting into the wards to practise our clinical skills on any poor patient naïve and awake enough to let us do so) outside of school hours is another.

Evidently, medicine is one hell of a marathon. But even from across the finish line, Adam Kay somehow administers more salve than salt. If anything, his hysterical insight into the ninth circle of this particular hell inspires (weary) pride and determination, and I already envision myself recalling the most preposterous anecdotes to pull me through the rest of my career. It is a strange contradiction.

Either way, this is a book everyone should read. In fact, especially people outside of the medical field. Looking pointedly at you, politicians. I only wish I had gotten onto the bandwagon earlier, when I was still cruising through my Enrichment Year, blissfully far from medical school. Maybe I wouldn’t have had a quarter-life crisis upon coming back if I had read this then.

Rating: 5 out of 5.

Being Mortal

Part review, part reflection. Maybe the withering aeroplane air was making my eyes watery. Maybe I wasn’t functioning properly with only two hours of sleep. For whatever reason, as I read this book on my flight to New York, I found it so profoundly moving at times, I even shed a few tears.

I am not unfamiliar with mortality and death; my eldest cousin passed away a few years ago, my father was hospitalised during the SARS epidemic, my great-great-aunt is in a nursing home and no longer remembers who I am, my mother had cancer, I wrote my IB Extended Essay on active and passive euthanasia. Yet I had never given serious thought to the social, cultural and economic crisis ageing has become.

In his fourth book, Gawande unpicks the crucial ingredients of a life, though limited by a body breaking down, that is still fulfilling. He also unpicks when it becomes wise to start letting go, and what letting go really means. He touches on euthanasia and assisted suicide, and how their implications run deeper than simply offering one more choice – they shape entire cultures’ perceptions of, reactions to and proposed solutions for the ageing population. And he does all this with a compelling, compassionate voice.

When put into written words, our attitudes towards dying and the dying are almost absurd. Our modern culture increasingly prioritises the children’s need for peace of mind over the ageing’s need for a dignified, autonomous life. And this prioritisation is viewed as the loving course of action. It is paternalism – a word the said children’s generation cringes at – reversed. The history of nursing homes likewise stems from logic that retrospectively sounds foolish: why don’t we shuttle the old and infirm into these hospital ward variants until they recover? Hence, “nursing” homes. The fact is, we never recover. The only certainty in life, after all, is death. So why do we so stubbornly pursue ever more aggressive invasive procedures and sterile, depressing ‘homes’ for the dying? This is the pressing question Gawande attempts to answer.

On a more personal note, like the AIDS patients in the Carstensen Hong Kong-American experiments, when my mother was diagnosed with cancer, her perspective was overhauled. By the time I was finishing primary school, I knew where my parents keep their share certificates, the passwords for all their financial documents, how to pay the electricity and water bills online, and the minutiae of their wills. Just in case I die in a freak accident, she would always say. I never had much interest in these conversations, not because I wanted to avoid thinking about death, but because her fixation had turned it into another mundane source of nagging. And an 11-year-old could only have so much interest in life insurance claims.

But Gawande pushed me to empathise with her fixation, which I shamefully admit I had never attempted to do. Being Mortal is an important book, not only for the generation that is currently ageing, but also (and perhaps more so) for the generation after. We are the ones who wield the power to shape how we will age in the future generations to come.

Rating: 4/5

Do No Harm: Stories of Life, Death, and Brain Surgery

Oui, another medical book. Sorry-not-sorry. But in all seriousness, this one offers a wholly different experience than other trending doctors’ books. It is no commentary on the wide world of providing healthcare, like two of Gawande’s publications. Nor is it a deeply philosophical exploration of certain diseases, like Sacks’ most successful collections. It is simply a raw, honest account of Marsh’s experiences, written in the register of a letter to a curious friend.

Do No Harm offers a refreshing vantage point from the perspective of a reputable neurosurgeon, a specialist who faces the especially daunting task of cutting into the very matter of our thoughts and emotions. Whilst the title may be a main principle of medical ethics (the fancy term is non-maleficence), the prose rarely enters the theoretical domain. Rather, Marsh chooses to focus on his concrete attempts to uphold it and his occasional failures to do so. So do not be hesitant because you anticipate heavy, abstract discussions, as those are almost completely absent.

Although Mr Marsh comes across in certain passages as possessing characteristics a typical patient would be unnerved to find in her surgeon (a susceptibility to temperamental outbursts, instances of hubris), the unflinching candour with which he recounts his experiences and fallibilities instead inspires empathy and understanding. After all, the book promises a riveting exploration of a profession dangerously familiar with death, and the heartbreaking disasters described are the reality of the medical industry.

As a first year medical student, his anecdotes vividly reminded me of the inevitability of my future mistakes or encounters with pure bad luck. Some of these may, in Marsh’s own words, “wreck” my patients. But instead of instilling a fatalistic attitude, Marsh inspires readers to strive ever more determinedly. I clearly recall a case in which, against the expectations of the Trust, he even encouraged a patient to sue, because his ultimate priority is unfalteringly his patients’ well-being.

Literarily, Marsh has a slight tendency to use repetitive language and excessively elaborate analogies. But once you become engrossed in his deeply personal accounts (as you quickly will), these minor annoyances are no longer noticeable. In fact, his sometimes fanciful imagery underlines the careful consideration and wonder with which he views his craft, even after all these years. In addition, unlike many medical publications aimed at laymen, Do No Harm is not organised around central themes. Some readers may find this style unstructured, but not knowing what revelations to expect when I began each new chapter made the reading experience more reminiscent of the twists and turns of a novel.

To conclude, Do No Harm is a thoroughly unpretentious book, addressing even the most devastating consequences without frills or excuses. Sometimes shocking, often moving, and always memorable, appreciators of the unique thrill and terror of treating the brain will not be disappointed.

Rating: 3.5/5

Better: A Surgeon’s Notes on Performance

Atul Gawande demonstrates his intuitive eye for captivating storytelling – the ability to spin a primarily scientific endeavour into an affecting narrative. Each description is sprinkled with the personal (perhaps unnecessary, from a medical viewpoint) details characteristic of a gripping novel, persuading even the least medically inclined readers that yes, it is pertinent, it is relatable, and it is certainly deserving of their attention. Above all, he has an extraordinary talent for making people care.

Better, his second book, is noticeably less personal that his first. Of course, Gawande still makes sure to thoughtfully contemplate, to paint the picture from his perspective. In fact, the most memorably section is the Afterword, which offers five concise suggestions for, very fittingly, becoming a better doctor or medical student. These suggestions were all drawn from his personal experiences. What do I mean by ‘less personal’ then? In Complications, like in Oliver Sacks’ renowned publications (see The Man Who Mistook His Wife for a Hat), many of the chapters focused on one or two cases that he was responsible for. The subsequent discussions were all anchored to these cases. In Better, however, many of the ‘cases’ were operations on a national, sometimes international, scale. Gawande travelled across states and continents to better understand these proceedings with unwavering determination, but the spotlight was no longer just illuminating his individual performance.

In my opinion, this made Better an even better read. It repeatedly reminded me that even if every doctor, nurse, pharmacist, technician, intern, government official relentlessly tried their very best to do better, the overall medical system is as at fault as these individuals in any room for improvement. The system in question can be a single hospital, a local healthcare plan, government policies or international NGOs. Furthermore, the victories are in the most mundane details – steady supplies of basic materials (a scalpel, a simple plastic tube), fundamental sanitary practices (washing hands)… Consistently establishing these as the routine can save significantly more lives than radical discoveries, but receives much less funding and attention than laboratory research.

To conclude, I highly recommend Better to anyone vaguely interested in the medical industry. It will pose questions, answer them, and make you want to ask even more. And it might even overturn how you think of medicine itself.

Rating: 4.5/5